What are the first-line antibiotics for the treatment of acute sinusitis?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Initial selection of the appropriate antibiotic therapy should be based on the likely causative organisms given the clinical scenario and the probability of resistant strains within a community. The course of treatment is usually 14 days. First-line therapy at most centers is usually amoxicillin or a macrolide antibiotic in patients allergic to penicillin because of the low cost, ease of administration, and low toxicity of these agents. Amoxicillin should be given at double the usual dose (80-90 mg/kg/d), especially in areas with known S pneumoniae resistance.

Table 1. Dosage, Route, and Spectrum of Activity of Commonly Used First-Line Antibiotics* (Open Table in a new window)

Antibiotic

Dosage

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Anaerobic bacteria

Sensitive

Intermediate

Resistant

Amoxicillin

500 mg PO tid

+++

++

+

++

+

+

Clarithromycin

250-500 mg PO bid

++

++

+

++

+++

+

Azithromycin

500 mg PO first day, then

250 mg/d PO for 4 days

++

++

+

++

+++

+

*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism


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